October 4, 2011

Surgeon Atul Gawande has a fine article in The New Yorker about his experience hiring a retired master surgeon to coach him on his scalpel technique the way top tennis and golf stars have swing coaches. Famous opera singers often employ vocal coaches, but, it's highly unusual for surgeons to seek outside criticism. I once attended a lecture by Tom Wolfe, who mentioned that surgeons and fighter pilots are the two most arrogant professions he had encountered.

Gawande is a moneyball surgeon who compares his annual performance (e.g., percentage of operation X that have complication Y) against national averages. He noticed that when he hit his mid-40s he had stopped improving. So he sought out an old teacher to watch a few of his operations and give him notes, which turned out to be quite useful.

Gawande goes on to visit a public school to watch ex-teachers coach teachers, and makes a big deal about how we should have -- revolutionary idea! -- coaching for teachers. Of course, we already have a lot of teacher teachers, maybe too many.

The economics of coaching works like this. Consider tennis. Lots of young people love the game and play for free in the hopes that someday they'll get good enough to get paid. But even those who do become tournament pros are typically physically washed up by 25 or 30. So, there is a huge supply of potential coaches relative to current tournament pros. Coaching offers them a chance to stay in the game in some fashion, even at reduced pay.

In contrast, in teaching, it's not clear when the average teacher gets too old for the classroom, but it's considerably older than when the average tennis pro gets too old for Wimbledon. What is clear, however, is that a lot of teachers get sick of teaching other people's children and would like to transition into a nice, child-free education job dealing mostly with other grown-ups, especially because the pay isn't less, it's the same or even higher. That's one reason for the huge expansion over the years in the number of staffers and consultants in school districts, most of whom are ex-teachers. Promoting your best teachers (to the extent that any school district knows who their best teachers are) to teach teachers might well hurt students more than help teachers.

Also, note that most relationships between individual sports athletes and their coaches are mutually voluntary. In contrast, school districts assigning ex-teachers to coach current teachers is less likely to be a good fit.

The problem with teaching is that it's a lot like being a doctor in the 18th Century. Erasmus Darwin, the grandfather of Charles Darwin and Francis Galton, was the most celebrated doctor in England. King George III asked him to cure him of his madness. Erasmus, no fool, turned him down.

You see, 18th Century doctors had relatively few ways to actually cure anybody of anything, so their reputations for healing the sick mostly depended upon their skill at "prognosis." Erasmus Darwin was the best at figuring out which potential patients would likely improve on their own and which wouldn't. He avoided the latter like the plague, even if they were the King of England. Similarly, nobody knows (or much cares) how good, say, Harvard is at teaching undergraduates. But Harvard is outstanding at prognosis of high school seniors. And that's what counts at present in education.

15 comments:

The thing about teaching is that the outcomes are largely determined by what the students can do and are willing to do, but the public discourse is weighted in the direction of what the teachers can do, and are willing to do.

Assuming decent instructional materials (texts, etc. which are simply purchased), the amount of knowledge skill, critical thinking ability, whatever, that a student acquires or develops in an instructional setting is probably something like 80% determined by the abilities and motivation of the student, and maybe 20% by the teacher -- and I may be overestimating in favor of the teacher here.

Bright, motivated people can learn quite a lot without any instructional guidance other than books and electronic sources. In fact, that's how they learn most of what they learn. People at the other end of the scale plateau pretty quickly, no matter what you do.

As a result, schools try one curriculum, then another, they put the desks in rows, then in circles, they switch textbooks, then issue everyone laptops. I'm not saying all of this is valueless (a lousy curriculum obviously does impede student progress), but a lot of it is just make-work for administrators so they can be seen to be "doing something" about shortcomings that are largely rooted in the students themselves.

Most people have few genuine interests that could be called "academic." That doesn't make them bad people, but we frustrate everyone by pretending that under the right system, and with the right teachers, they can all be made interested in and proficient at subjects which do not interest them, and for which they have no particular aptitude.

I was reading just last week the part in Darwin's autobiography where he explains that he received his queasiness about blood from his father, and writes that this was a problem for his father because he was a doctor who hated practicing medicine and would have given it up if he'd had any other source of money.

Yes, the son of Erasmus Darwin and father of Charles Darwin was a doctor. He didn't much like his profession and told Charles that he was proudest of minimizing the amount of blood he leeched out of his patients. Did he have to argue with his patients not to leach them?

Somebody should make up a list of all the famous people, like Charles Darwin and Francis Galton, whose fathers wanted them to be either doctors or lawyers. Awhile ago I read up on the lives of famous composers on Wikipedia, and one recurrent theme, across hundreds of years, was how many of them had to rebel against their families plans for them to become lawyers.

One thing you could say for lawyers back then, however, was that, on average, they won half their cases, while doctors might have made their patients worse on average by bleeding and spreading infections by not washing their hands.

Having an ex-wife who is a doctor, I am used to hearing doctors opinions of surgeons. It is not that high. Surgeons are the "plumbers" or "mechanics" of their business. They need good eye hand coordinatin and be handy with saws, knives, etc. but they are not necessarially good at diagnosing anything which is where the real brain power comes into to being a doctor.

"and how many of them had to rebel against their families plans for them to become lawyers."

If only their parents were as supportive as Teddy Roosevelt's father, they might dropped their youthful rebellion and gone into politics.

My father had from the earliest days instilled into me the knowledge that I was to work and to make my own way in the world, and I had always supposed that this meant that I must enter business. But in my freshman year (he died when I was a sophomore) he told me that if I wished to become a scientific man I could do so. He explained that I must be sure that I really intensely desired to do scientific work, because if I went into it I must make it a serious career; that he had made enough money to enable me to take up such a career and do non-remunerative work of value if I intended to do the very best work there was in me...http://www.bartleby.com/55/

Tom Wolfe, who mentioned that surgeons and fighter pilots are the two most arrogant professions he had encountered

Wolfe obviously has never encountered Theoretical Physicists. But to be fair, their arrogance is founded on a far more rational basis.

The interest in Gawande's story is precisely because doctors rarely think of medicine in such analytic terms. When it comes to modestly g-loaded tasks like even basic statistics, even the most intellectual research physicians are laughably innumerate based upon the frequency and type of errors that pass for medical research today.

As for fighter pilots, think of how much of an unwarranted ahole John McCain was as a young man if he swears at fellow Senators in his 70s.

One of the favorite "remedies" of those old-timey physicians was mercury, used as a cure for syphilis and as a regular old panacea in general (hence the word "quack" from the Dutch word for mercury (quacksalver).

18th C? Try 20th C through the first few decades! Prognosis was indeed what doctors were good at. They could tell you if your heart was good enough to go into the army. They could make some estimate how long whatever you had might take to kill you. They had a stock of mild medicines that could at least help you stop worrying. They could set a bone.

In our health-care discussions, we overlook the fact that medicine is expensive because we can finally do something, even magic. And any medieval alchemist or D&D player can tell you that magic is expensive.

Having an ex-wife who is a doctor, I am used to hearing doctors opinions of surgeons. It is not that high. Surgeons are the "plumbers" or "mechanics" of their business. They need good eye hand coordinatin and be handy with saws, knives, etc. but they are not necessarially good at diagnosing anything which is where the real brain power comes into to being a doctor.

That's pretty interesting - I'll keep that in mind. I've sort of come to the opposite conclusion - most GP's, at least, don't really know all that much (at least there's often no consistency among diagnoses, so it seems they're guessing). But I've always assumed surgeons are the real deal.

IM Kane points out that in a recent commentary, NFL Hall of Fame quarterback Fran Tarkenton asks readers to imagine the National Football League with public education's rigid, union-dictated system that rewards tenure instead of performance.

"Each player's salary is based on how long he's been in the league. ... The same scale is used for every player, no matter whether he's an All-Pro quarterback or the last man on the roster. For every year a player's been in this NFL, he gets a bump in pay. The only difference between Tom Brady and the worst player in the league is a few years of step increases. And if a player makes it through his third season, he can never be cut from the roster until he chooses to retire, except in the most extreme cases of misconduct.

No matter how much money was poured into the league, it wouldn't get better. … [A] few wild-eyed reformers might suggest the whole system was broken and needed revamping to reward better results, but the players union would refuse to budge and then demonize the reform advocates: "They hate football. They hate the players. They hate the fans." The only thing that might get done would be building bigger, more expensive stadiums and installing more state-of-the-art technology. …

Over the past 20 years, we've been told that a big part of the problem is crumbling schools—that with new buildings and computers in every classroom, everything would improve. But … [w]e've been spending billions of dollars on school modernization for decades, and I suspect we could keep on doing it until the end of the world, without much in the way of academic results. The only beneficiaries are the teachers unions.

The results we're looking for are students learning, so we need to reward great teachers who show they can make that happen—and get rid of bad teachers who don't get the job done. It's what we do in every other profession: If you're good, you get rewarded, and if you're not, then you look for other work."—Fran Tarkenton

The American Federation of Teachers (AFT) and the National Education Association (NEA) control the smaller education unions and set the agenda for public education nationwide. In fact, the NEA lobby is one of the most powerful political forces in the country.

"The NEA has been the single biggest obstacle to education reform in this country. We know because we worked for the NEA."—Billy Boyton and John Lloyd former Executive Directors of NEA affiliates in Nebraska and Kansas respectively

Unfortunately the condition of the nation's public education system makes the following Oscar Wilde epigram more prescient than witty:

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